NICU quality improvement initiative reduced vancomycin treatment


New exploration study exhibits 66% reduction in vancomycin use in individuals, improved client outcomes


July 01, 2020

A good quality improvement initiative in the Neonatal Intense Care Device (NICU) at Children’s Countrywide Medical center led to a substantial reduction in treatment method with intravenous vancomycin, an antibiotic employed for resistant gram beneficial bacterial infections, which is typically involved with acute kidney damage. The results, published in the journal Pediatrics, present the initiative diminished vancomycin use in individuals by 66%, and the NICU has sustained the reduction for a lot more than a year. 

Vancomycin is a wide-spectrum antibiotic typically employed to deal with methicillin-resistant Staphylococcus aureus (MRSA) an infection. It is one particular of the most commonly prescribed antibiotics in NICUs, but its overuse poses an improved possibility of morbidity. Benchmarking facts confirmed that in 2017, vancomycin use at Children’s Countrywide Medical center was considerably bigger than use at peer establishments, suggesting there was possible an opportunity to enhance use of this drug.

The intervention system was led by Rana Hamdy, M.D., M.S.C.E., M.P.H., an infectious ailments specialist at Children’s Countrywide, Lamia Soghier, M.D., medical device director of the Children’s Countrywide NICU, and other workforce customers from neonatology, infectious ailments, pharmacy, nursing and good quality improvement. The workforce attained the perscribing reduction by sequentially employing a 4-step tactic involving interdisciplinary workforce setting up and supplier education, pharmacist-initiated forty eight-hour time-outs, clinical pathway enhancement and possible audit with suggestions.

“Our interdisciplinary good quality improvement workforce was devoted to this undertaking and executed interventions that, early on, led not only to reduction in vancomycin use, but to far better outcomes in our individuals with less episodes of vancomycin-involved acute kidney damage,” said Dr. Hamdy. “This led to early purchase-in from the prescribers, finally modifying the tradition of antibiotic prescribing in the NICU.”

Pursuing the NICU’s intervention system to enhance client safety, vancomycin use in individuals decreased from 112 days of treatment per 1,000 client-days to 38 days of treatment per 1,000 client-days. For the duration of the intervention system, the researchers pointed out that this was “the initial do the job to present a substantial modify in vancomycin-involved acute kidney damage in neonates.”

Four crucial interventions were being sequentially executed to effectively accomplish and maintain the reduction in vancomycin use. Intervention 1 was the enhancement of an interdisciplinary and supplier education workforce that resolved institutional antibiotic prescribing methods. Intervention 2, a pharmacist-initiated forty eight-hour time-out, included clinical pharmacists identifying individuals who have been on antibiotics for ≥ forty eight hrs and encouraged their companies to possibly discontinue vancomycin or to swap to a slim-spectrum antibiotic. Intervention three consisted of the enhancement of new clinical pathways together with discontinuing vancomycin in infants at reduced-possibility for MRSA. Last of all, intervention 4, antimicrobial stewardship system (ASP) possible audit and suggestions, included an ASP member examining all NICU vancomycin orders and issuing correct recommendations for NICU companies and pharmacists to be carried out inside 24 hrs. 

This undertaking was taken on as component of Children’s Countrywide Excellent Advancement and Management Schooling (QuILT) training course sponsored by the Excellent & Protection Department. This notable do the job was highlighted in the 2019 annual Excellent and Protection report and by the Magnet system as an exemplary example of nursing-health practitioner partnership functioning to enhance client care. 

The involved posting, “Reducing Vancomycin Use in a Stage IV Neonatal Intense Care Device,” will be published July 1 in Pediatrics. The guide author is Dr. Rana Hamdy, an infectious ailments specialist and director of the Antimicrobial Stewardship Plan. 20 notable co-authors are also from Children’s Countrywide. 

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